Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Topiramate(click to collapse)
1/4 selected
Topiramate
Topamax · Qsymia
Anticonvulsant
FDA-approved indications
- Epilepsy — initial monotherapy (partial-onset or PGTC; 2+ years)
- Epilepsy — adjunctive (partial-onset, PGTC, Lennox-Gastaut; 2+ years)
- Migraine prophylaxis (12+ years)
Off-label uses
- Alcohol use disorder
- Binge eating disorder
- Bulimia nervosa
MechanismAnticonvulsant (multiple mechanisms: sodium channel blockade, GABA-A potentiation, glutamate antagonism, carbonic anhydrase inhibition)
Half-life21 hours
Decision GuideWhen to pick each / when to consider an alternative
Topiramate
Consider when
- Alcohol use disorder (off-label) — strongest evidence among anticonvulsants for reducing heavy drinking; may rival naltrexone efficacy
- Migraine prophylaxis with weight concern — FDA-approved for migraine prevention; weight-loss effect beneficial in overweight patients
- Weight loss desired as side effect — dose-dependent weight loss; component of Qsymia (phentermine/topiramate) for obesity
- Epilepsy with comorbid migraine or bipolar — FDA-approved for epilepsy and migraine; mood-stabilizing properties off-label
- +1 more
Consider an alternative when
- Cognitive impairment concern — dose-dependent word-finding difficulty, processing speed reduction; 'dopamax' nickname; worst cognitive profile among anticonvulsants
- Kidney stone history — 1.5% incidence; carbonic anhydrase inhibition reduces urinary citrate; contraindicated with stone history
- Metabolic acidosis risk — carbonic anhydrase inhibition causes non-anion-gap metabolic acidosis; monitor bicarbonate
- Pregnancy or unreliable contraception — category D; oral cleft risk (0.5%); contraindicated in pregnancy for migraine/weight
- +1 more
| Axis | Topiramate anticonvulsant |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
| CNS | |
Sedation / somnolence | |
Cognitive dulling / anterograde amnesia | |
Dizziness | |
| Metabolic | |
Weight loss | |
Metabolic (glucose / lipids) | |
Appetite suppression / anorexia | |
Hyperammonemia / encephalopathy | |
| Endocrine | |
Renal effects | |
| Pediatric | |
Growth suppression (pediatric) | |
| Autonomic | |
Angle-closure glaucoma | |
| Sensory | |
Visual disturbances (blurred vision, diplopia, lens changes) | |
| Pregnancy | |
Teratogenicity | |
| Drug-specific / distinctive axes | |
Axis 4 — Paresthesia (distinctive AE) only in Topiramate | |
Axis 9 — Oligohidrosis / hyperthermia (W&P 5.3) only in Topiramate | |
Axis 15 — Serious skin reactions (W&P 5.11) only in Topiramate | |